Reopolyglucin with glucose (solution for infusion)
Rheopolyglucinum cum glucoso
International unlicensed name
Dextran.
Pharmacotherapy group
Rehydrants. Regulators of water-salt balance and ABB. Detoxicant.
Composition
1 l of solution for infusion contains dextran 100 g with molecular mass from 30000 to 40000, glucose 50 g.
Pharmacological action
Pharmacodynamics
Rheopolyglucin with glucose is a plasma-substituting antishock preparation of hemodynamic action. It contributes to increasing of the volume of plasma almost twice in comparison with the volume of the administered preparation, as each gram of glucose polymer with molecular mass 30000—40000 induces the transportation of 20—25 ml of liquid from the tissues into the blood bed. Due to high oncotic pressure rheopolyglucin slowly penetrates through the vase wall and circulates for long in the vascular bed normalizing hemodynamics thanks to the fluid current at the concentration gradient -- from the tissues into vessels. As a result, blood pressure increases and keeps for long at a high level, and tissue edema reduces.
Rheopolyglucin with glucose may be used as a detoxication preparation. On its administration blood fluidity improves and formed element aggregation reduces. It stimulates diuresis with osmotic mechanisms (it filtrates in glomerules, creates high oncotic pressure in the primary urine and prevents the reabsorption of water in tubules) that secures (and intensifies) the removal of toxins, degradation metabolism products from the organism.
Pharmacokinetics
Dextran contained in the preparation is mainly excreted from the organism by kidney: On the first day about 70% of the preparation is excreted unaltered. The certain part of dextran enters into the reticuloendothelial system where it is split into glucose. It does not participate in the carbohydrate metabolism. A small part of dextran can penetrate into gastrointestinal tract and excreted in the faeces.
Glucose: on intravenous administration it leaves quickly the vascular bed. Molecula of glucose are utilized in the process of energetic supply to the organism. On entering into the tissue glucose phosphorylates and transforms into glucose-6-phosphate that is further included into the metabolism (end products of metabolism are carbonic acid and water).
Indication
Rheopolyglucin with glucose is used in patients to improve capillary blood flow for prophylaxis and treatment of traumatic, operational, toxic and burn shock; to improve arterial and vein blood circulation for prophylaxis and treatment of thrombosis, thrombophlebitis, Raynaud’s disease; as well as it is added into perfusion fluid in the heart-lung machine on operations on heart; is used to improve the microcirculation and reduce the disposition to thrombosis in the transplant on vascular and plastic operations, for detoxication on peritonitis, pancreatitis, ulcerous-necrotic enterocolitis; toxic dyspepsia. When it is necessary to infuse blood or its components, administration of rheopolyglucin cannot substitute hemotransfusion.
Route and dosage
The dose and speed of administration depend on the patient’s condition and assay.
On capillary blood flow disturbances (different forms of shock) it is administered intravenously drop-by-drop in the dose of 400 to 1000 ml for 30—60 minutes, if necessary, the amount of the preparation can be increased up to 1500 ml. In children on different forms of shock rheopolyglucin with glucose is administered in the dose of 5—10 ml/kg, if necessary the dose can be increased up to 15 ml/kg.
On cardiovascular and plastic operations rheopolyglucin with glucose is administered intravenously drop-by-drop immediately before the surgical operation for 30—60 minute in the dose of 10 ml/kg (in children at the age of older than 5 in the dose of 10 ml/kg), during the operation -- 400—500 ml (in children – up to 15 ml/kg) and after the operation during 5 – 6 days drop-by-drop in the dose of 10 ml/kg in the single dose. In children at the age younger than 2—3 years old the preparation is administered in the dose of 10 ml/kg once a day for 60 minutes, in children younger than 8 years old — in the dose of 7—10 ml/kg for 60 minutes once and rarely two times a day, in children younger than 14 years old -- in the dose of 5—7 ml/kg for 60 minutes once or two times a day, for children older than 14 years old – the same doses as in adults.
On operations with heart-lung bypass, rheopolyglucin with glucose is added into blood in the dose of 10—20 ml/kg to fill the oxygenator pump.
In the post-operation period the dose of the preparation is the same as that for capillary blood flow disturbances.
For detoxication rheopolyglucin with glucose is administered intravenously drop-by-drop in the dose from 400 to 1000 ml (in children 5—10 ml/kg for 60—90 minutes). If necessary, on the first day one can infuse 400—500 ml of the preparation more (in children the administration of rheopolyglucin can be repeated in the same dose on the first day). On the following days the preparation is administered drop-by-drop in the dose of 400 ml per day (in children on the following days the preparation is administered in the same way as in the post-operation period).
Together with rheopolyglucin with glucose crystalloid solutions (isotonic sodium chloride, glucose solution 5%, etc.) can be administered in the same amount in order to restore and keep liquid and electrolytic balance. It is especially important on treatment of dehydrated patients and patients after surgical operations. The preparation induces diuresis. Though, provided that on treatment with rheopolyglucin with glucose the reduction in diuresis accompanied by secretion of jellied syrupy urine is observed, it may constitute the symptoms of patient's organism dehydration. In this case crystalloid solutions should be administered in order to restore and keep the liquid and electrolytic balance.
Special indications
The presence of dextrane affects the laboratory results of bilirubin and protein concentration. Therefore, it is recommended to take blood samples for bilirubin and protein concentration before the administration of the preparation.
Side effects
Complications following the administration of rheopolyglucin with glucose are usually not observed, though in rare cases allergic reactions are possible. It is recommended to start the administration drop-by-drop and after first 2—5 ml a break for three minutes is necessary to assess the situation (bioassay on compatibility).
In case of anaphylactic reactions (reddening, itching, Quincke's edema) during the infusion, it is strongly recommended to stop the administration and, without extracting the needle from the vein, start the corresponding therapy to eliminate the transfusion reaction (antihistaminic and cardiovascular preparations, corticosteroids, respiratory analeptics, etc.).
Contraindications
Contraindications to the use of rheopolyglucin with glucose are: hypersensitivity, decompensated cardiovascular failure; craniocerebral injuries with increase intracranial pressure; hemorrhage stroke; continuous inner hemorrhage; hypocoagulation; thrombocytopenia; distinct compromised kidney function with oligo- and anuria; hypervolemia, hyperhydration and other cases in which the infusion of large amount of fluid is contraindicated.
Rheopolyglucin should not be administered on carbohydrate disturbances, especially on insulin diabetes.
Precautions
It is recommended to start the administration drop-by-drop and after first 2—5 ml a break for three minutes is necessary to assess the situation (bioassay on compatibility).
Interaction with other medications
The preparation can be used in combination with other widely used transfusion preparations. It is necessary to control the compatibility of dextran with other medications that are planned to be added into the infusion solution.
Aminocapronic acid, hydralazin, warfarin, ethanol 95%, dexamethasone and other medicines are not compatible with dextran.
Product form
Solution for infusions in a bottle 200 and 400 ml.
